Provider Demographics
NPI:1144051665
Name:LUNDQUIST, JORDAN REED (DMD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:REED
Last Name:LUNDQUIST
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-1236
Mailing Address - Country:US
Mailing Address - Phone:724-238-9553
Mailing Address - Fax:724-238-9554
Practice Address - Street 1:226 N MARKET ST
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-1236
Practice Address - Country:US
Practice Address - Phone:724-238-9553
Practice Address - Fax:724-238-9554
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS044644122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist